What about tirzepatide for weight loss in patients with type 2 diabetes?

From the Guidelines

Tirzepatide is a highly effective medication for weight loss in patients with type 2 diabetes, with clinical trials showing a mean weight loss of 15-20% over 72 weeks. The medication, sold under the brand name Mounjaro, is FDA-approved for type 2 diabetes and can produce significant weight reduction as a beneficial side effect.

Key Points

• The typical starting dose is 2.5 mg injected subcutaneously once weekly for 4 weeks, then increased gradually to 5 mg, 7.5 mg, 10 mg, and potentially up to 15 mg weekly as tolerated 1.
• Clinical trials have shown that patients with type 2 diabetes can lose approximately 15-20% of their body weight over 72 weeks on tirzepatide, which is substantially more than with other diabetes medications 1.
• This weight loss occurs because tirzepatide acts as a dual GIP/GLP-1 receptor agonist, which reduces appetite, slows gastric emptying, and improves insulin sensitivity.
• Common side effects include nausea, vomiting, diarrhea, and constipation, which typically improve over time.
• Patients should start with the lowest dose and increase gradually to minimize gastrointestinal side effects.
• They should also maintain a healthy diet and exercise regimen while using tirzepatide for optimal results.
• Blood glucose monitoring is important during treatment, as insulin or other diabetes medication doses may need adjustment due to improved glycemic control.

Comparison with Other Medications

• A recent meta-analysis of RCTs that included 12,371 adults with overweight or obesity without diabetes reported that 15 mg weekly of tirzepatide was associated with greater weight loss compared with 2.4 mg weekly of subcutaneous semaglutide and 3 mg daily of subcutaneous liraglutide 1.
• Tirzepatide probably reduces severe hypoglycemia compared with insulin, with a relative risk of 0.21 (CI, 0.11 to 0.38) 1.

From the FDA Drug Label

Tirzepatide lowers fasting and postprandial glucose concentration, decreases food intake, and reduces body weight in patients with type 2 diabetes mellitus.

Tirzepatide is effective for weight loss in patients with type 2 diabetes, as it decreases food intake and reduces body weight in addition to its glucose-lowering effects 2.

• Key benefits of tirzepatide for weight loss in type 2 diabetes patients include:
  • Reduction in body weight
  • Decrease in food intake
  • Improvement in glucose control
• Mechanism of action: Tirzepatide is a GIP receptor and GLP-1 receptor agonist, which enhances first- and second-phase insulin secretion and reduces glucagon levels in a glucose-dependent manner 2.

From the Research

Tirzepatide for Weight Loss in Patients with Type 2 Diabetes

• Tirzepatide is a dual GIP/GLP-1 receptor co-agonist that has shown unmatched effectiveness in regards to glycaemic control and body weight reduction in patients with type 2 diabetes 3.
• Clinical trials have demonstrated that tirzepatide reduces both HbA1c and body weight by amounts unprecedented for a single agent, with a sizable proportion of patients reaching an HbA1c of < 5.7% and losing more than 10% of their baseline body weight 3, 4, 5.
• The SURPASS clinical trial program has shown that tirzepatide is significantly more effective in reducing HbA1c and body weight than the selective GLP-1 RA semaglutide and titrated basal insulin 3, 5.
• Adverse events related to tirzepatide were similar to what has been reported for selective GLP-1RA, mainly nausea, vomiting, diarrhoea, and constipation, that were more common at higher doses 3, 6.

Efficacy and Safety of Tirzepatide

• Tirzepatide has been found to improve insulin sensitivity and insulin secretory responses to a greater extent than semaglutide, and this was associated with lower prandial insulin and glucagon concentrations 3.
• The safety profile of tirzepatide was consistent with that of the GLP-1 receptor agonist class, with mild to moderate and transient gastrointestinal side effects being the most common adverse events 6.
• Tirzepatide has demonstrated potential as a first-in-class treatment option for many people with type 2 diabetes, with clinically and statistically significant reductions in A1C and body weight without increased risk of hypoglycemia 6.

Tirzepatide for Overweight and Obesity Management

• Tirzepatide is also approved for chronic weight management, and has been found to enable many patients to achieve ≥ 20% weight loss 7.
• The SURMOUNT program has shown that tirzepatide is well-tolerated with a safety profile similar to GLP-1 receptor agonists, and results in clinically important improvements in multiple obesity-related complications 7.
• Ongoing trials will provide further data on tirzepatide's long-term safety, efficacy, and potential cost-effectiveness for managing overweight/obesity and/or type 2 diabetes 7.